1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security |
5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Series C-1 Convertible Preferred Stock
|
Â
(1)
|
Â
(2)
|
Common Stock
|
246,380
|
$
(1)
|
I
|
By CID Equity Capital VIII, L.P.
(3)
|
Series C-3 Convertible Preferred Stock
|
Â
(1)
|
Â
(2)
|
Common Stock
|
41,855
|
$
(1)
|
I
|
By CID Equity Capital VIII, L.P.
(3)
|
Series C-1 Convertible Preferred Stock
|
Â
(1)
|
Â
(2)
|
Common Stock
|
123,190
|
$
(1)
|
I
|
By CID Seed Fund, L.P.
(4)
|
Series C-3 Convertible Preferred Stock
|
Â
(1)
|
Â
(2)
|
Common Stock
|
20,705
|
$
(1)
|
I
|
By CID Seed Fund, L.P.
(4)
|
* |
If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** |
Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) |
The reported securities are convertible at any time at the option of the reporting person, but automatically convert into shares of Common Stock on a 1-for-1 basis immediately prior to the closing of the Issuer's initial public offering. |
(2) |
Not applicable. |
(3) |
John Aplin is a Class A member of CID Equity Partners VIII, LLC, which has the ultimate voting and investment power over shares held of record by CID Equity Capital VIII, L.P., and he may be deemed to have voting and investment power over shares held of record by CID Equity Capital VIII, L.P. Mr. Aplin disclaims beneficial ownership of the shares directly held by the entities affiliated with CID except to the extent of his individual pecuniary interest therein. |
(4) |
John Aplin is a general partner of CID Seed Fund Partners I which has the ultimate voting and investment power over shares held of record by CID Seed Fund, L.P., and he may be deemed to have voting and investment power over shares held of record by CID Seed Fund, L.P. Mr. Aplin disclaims beneficial ownership of the shares directly held by the entities affiliated with CID except to the extent of his individual pecuniary interest therein. |